术中氯胺酮与视频辅助胸腔镜手术（VATS）后的疼痛：系统回顾与元分析》。

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-10-16 DOI:10.1016/j.accpm.2024.101444

Umar Akram , Zain Ali Nadeem , Haider Ashfaq , Eeshal Fatima , Hamza Ashraf , Muhammad Ahmed Raza , Shahzaib Ahmed , Arsalan Nadeem , Sana Rehman , Muhammad Hassan Ahmad

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引用次数: 0

摘要

背景：视频辅助胸腔镜手术（VATS与开胸手术相比，视频辅助胸腔镜手术（VATS）可减少术后不适，加快恢复。有效的术后疼痛管理对促进恢复和减少并发症至关重要。氯胺酮是一种 NMDA 受体拮抗剂，虽然其在 VATS 中的疗效仍不确定，但已显示出良好的前景。本荟萃分析旨在评估氯胺酮在减轻 VATS 患者急性疼痛方面的有效性和安全性：方法：对 MEDLINE (PubMed)、CENTRAL、Embase、Science Direct、Scopus 和 clinicaltrials.gov 进行了全面检索。符合条件的研究均为随机对照试验（RCT），这些试验对 VATS 患者术中静脉注射氯胺酮与生理盐水进行了比较，并报告了术后疼痛评分。统计分析使用 R 4.3.3 版本进行。Cochrane偏倚风险（RoB2）工具用于评估纳入研究的质量：结果：共纳入了 10 项研究，1,151 人参与。氯胺酮可显著减轻术后 12 小时（MD -0.65，p = 0.04）和 48 小时（MD -0.55点，p 结论：氯胺酮可显著减轻术后疼痛：术中静脉注射氯胺酮可有效减轻 VATS 患者的术后急性疼痛，但对阿片类药物的用量、血流动力学参数和不良反应没有明显影响。需要进行大规模研究来证实这些发现，并探索氯胺酮对慢性疼痛治疗的潜在益处：PROCROPERO（CRD42024527858）。

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Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis

Background

Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.

Methods

A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.

Results

A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.

Conclusions

Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.

Registration

PROSPERO (CRD42024527858).

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.